Exam I Review Pharm PDF

Test Review Wednesday, January 15, 2025 11:56 AM 90% of questions below!! 50 questions total Indication (BIG know) - categorize what they're used for, classification, MOA for most drugs Vitamins, Minerals, Herbs (use both names for vitamins listed) Brand Generic Diseases/disor...

Test Review Wednesday, January 15, 2025 11:56 AM 90% of questions below!! 50 questions total Indication (BIG know) - categorize what they're used for, classification, MOA for most drugs Vitamins, Minerals, Herbs (use both names for vitamins listed) Brand Generic Diseases/disorders MOA or xtra info name name Vitamin cyanocobalam Macrocytic anemia Decreased intrinsic factor (age > 50 or taking B12 in metformin) Vitamin B9 Folic acid Reduction of neural tube defects Calcium Osteoporosis Ergocalciferol (D2) is Rx and cholecalciferol and Vit D (D3) is OTC Vitamin D should no longer be dosed in IU (international units) … but it still is Iron Microcytic anemia Vitamin E Topical for scar minimization Coenzyme ○ Rate-limiting cofactor in mitochondrial Q10 adenosine triphosphate (ATP) formation ○ Reduction of statin-associated adverse effects Fish Oil Hypertriglyceridemia and Omega-3 fatty acids DHA / EPA inflammatory conditions Red Yeast Hypercholesteremia Molecular structure similar to statins Rice Vitamin B3 Niacin Hypercholesteremia NAD & NADP precursor for mitochondrial redux reactions Gingko Alzheimer’s disease Neuroprotective properties biloba (AD Vascular dementia Attention deficit /hyperactivity disorder (ADHD) Tardive dyskinesia Intermittent claudication Tinnitus Acute mountain sickness Age-related macular degeneration Melatonin Insomnia and jetlag Hormone and potent antioxidant produced by the pineal gland St. John’s Hypericum Depression, anxiety and wort perforatum OCD flower Valerian Valeriana Insomnia and anxiety root officinalis Kava Piper Ceremonial tranquilizer May cause severe liver damage methysticum for Pacific Islanders Kratom Mitragyna Psychoactive with both speciosa stimulant and opioid-like effects CBD Cannabis Used for everything??? Use proliferated after passage of the 2018 sativa Farm Bill ○ Prevent and treat colds – Echinace may decrease duration of a infection ○ Sambuc us nigra (elderber ry) ○ Vitamin C (ascorbi c acid) ○ Zinc Probiotics GI flora restorations Refrigerated products are preferred by gastroenterologist Florajen (≈$30) and VSL (≈$60) Glucosamin Osteoarthritis Stimulates chondrocytes to produce cartilage e and and synoviocytes to produce synovial fluid and chondroitin hyaluronic acid, inhibits matrix metalloproteinase, and modulates activities of inflammatory cytokines; also serves as “building blocks” for cartilage Saw BPH Inhibits 5-alpha-reductase and cytosolic palmetto androgen receptor Black Cimicifuga Premenstrual syndrome, cohosh racemose dysmenorrhea, and menopause Evening Oenothera PMS and menopause primrose biennis oil Salicylic acid concentrations (acne vs warts) Acne: 0.5 - 2% Warts: 17 - 40% Pregnant patients in OTC lecture + Everything about lactation Disease Pregnancy Lactation Headache NSAIDs contraindicated in 3rd trimester Avoid aspirin s Delayed parturition Safe: Ibuprofen & APAP Prolonged labor Ibuprofen: relevant infant Inc postpartum bleeding dose is 0.6-0.9% Premature closure of the ductus arteriosus APAP: 3.98% Avoid aspirin Colds 1st line: intranasal cromolyn Pseudoephedrine compatible (may 1st line nasal decongestant: oxymetazoline if decrease milk production) there is severe congestion Intranasal cromolyn & INCS Phenylephrine: 1st trimester - minor malformations probably compatible (inguinal hernia, congenital hip dislocation) Antihistamines contraindicated Pseudoephedrine: abdominal wall defects (gastroschisis) Don’t use in 1st trimester Diphenhydramine & chlorpheniramine are preferred antihistamines (can use 2nd gen too) INCS: compatible - systemic use associated w/ cleft lip and palate and low birth weight Heartburn Lifestyle modifications Calcium antacids H2RAs **avoid PPIs** Antacids/PPRI/H2HR: Antacids: How fast: 5 minutes Adverse effects: ○ Magnesium hydroxide: diarrhea ○ Aluminum hydroxide: constipation ○ Calcium carbonate: renal calculi possible if preexisting renal impairment ○ Sodium bicarbonate: alkalosis possible if preexisting renal impairment Drug interactions: ○ Chelation via divalent cations --> able to bind easily to… Doxycycline Ciprofloxacin Levofloxacin Histamine Type 2 Receptor Antagonists: How fast: 30-45 minutes Adverse effects: ○ Cimetidine: antiandrogenic effects Decreased libido Impotence Gynecomastia in men Drug interactions: ○ Cimetidine inhibits CYP 450, 1A2, 2C19 Phenytoin Warfarin Amiodarone Clopidogrel Nifedipine Theophylline Tricyclic Antidepressants Opioids Protein Pump Inhibitors (PPI): How fast: 60 minutes Adverse effects: ○ C.diff infection ○ Spontaneous bacterial peritonitis w/ pts w/ ascites secondary to cirrhosis ○ Increased risk of osteoporosis with long term or multi daily use Drug interactions: ○ Omeprazole: inhibits CYP 2C19 Citalopram Clopidogrel Warfarin Tacrolimus mycophenolate **Increasing the pH of the stomach will cause lots of drug interactions** *azoles, protease inhibitors, fluoroquinolones, thyroxine, digoxin and others* Adverse effect or drug interactions (only if highlighted aka talked about) APAP: ○ Nausea ○ Vomiting ○ HA ○ Insomnia Cholinergic blockers (diphenhydramine, chlorphenamine, doxylamine): ○ Dryness of the eyes and mucous membranes (mouth, nose, vagina) ○ Blurred vision ○ Urinary hesitancy and retention ○ Constipation ○ Reflex tachycardia Benadryl (diphenhydramine): ○ Sleepiness Intranasal corticosteroids: ○ Changes in vision ○ Glaucoma ○ Cataract formation  ○ Increased risk of fungal infections ○ Growth inhibition in children Intranasal corticosteroids + PIs ○ Cushing's syndrome Afrin: ○ Rebound congestion Codeine: ○ Serious, life-threatening, or fatal respiratory depression ○ Risk of opioid addiction, abuse, and misuse Dextromethorphan + CYP 2D6 inhibitors (bupropion, fluoxetine & paroxetine) ○ Psychoactive effects REVIEW antiacids above *drug interactions most likely to occur with antidepressants and blood thinners Always know anticholinergic effects dry mouth blurry vision constipation urinary retention (rarely) Afrin: Oxymetazoline ○ Only use for 3 consecutive days ○ Can cause rebound congestion - rhinitis medicamentosa Combo products: Look at each product listed - tell whether or not its accepted for use within that context; Any FDA concerns; Contraindications based on current health status/medications/pregnancy (refer to pregnancy table); *for each drug in combo Phenylephrine (Sudafed PE): FDA: product is ineffective as of 2023 Found in solo and combo products Pseudoephedrine (Sudafed D): Found in solo and combo products FDA: ○ Limit use for pts with HTN (may use 30mg tablets at lowest possible frequency for 3 days if BP is controlled) ○ Purchase limits imposed - illegal meth manufacturing Guaifenesin + pseudoephedrine (Mucinex D): Guaifenesin: loosens and things lower respiratory tract secretions Pseudoephedrine: In combo - large doses have been associated w/ renal calculi development Guaifenesin + dextromethorphan (Mucinex DM): Guaifenesin: loosens and things lower respiratory tract secretions Dextromethorphan: decreases sinusoid vessel engorgement and mucosal edema Practice math questions 1. Convert lbs to kg 2. Multiply kg by max dose per day/hours (mg/kg/day(or hours)) 3. Then multiply by oral solution amount (mL/mg) --> gives you max daily dose or dose every __ hours 4. **divide solution of #2 by how many times daily (ex. BID, TID, QID) if needed Aspirin/NSAIDS/APAP (Drug interactions, Adverse effects, Antidote for Tylenol, MOA) Drug MOA Adverse Effects Drug Interactions Acetaminoph Central inhibition of Nausea, vomiting Substances that induce en prostaglandin synthesis Headache or regulate hepatic Insomnia cytochrome enzyme Hepatotoxicity: CYP2E1 may alter the Metabolized by metabolism of CYPP450 --> toxic  intermediate that is acetaminophen and inc detoxified by hepatotoxic potential glutathione (phase II conjugation) TREAT with activated charcoal or acetylcysteine Ibuprofen Relieve pain through central GI ulceration, bleeding Methotrexate (NSAID) and peripheral inhibition of Inc risk for MI, heart failure P2Y12 inhibitors and cyclooxygenase (COX) w/ HTN, stroke SSRIs consequent inhibition of Edema Bisphosphonates prostaglandin synthesis Nephropathy Digoxin Phenytoin and ibuprofen together Naproxen Relieve pain through central GI ulceration, bleeding Methotrexate (NSAID) and peripheral inhibition of Inc risk for MI, heart failure P2Y12 inhibitors and cyclooxygenase (COX) w/ HTN, stroke SSRIs consequent inhibition of Edema Bisphosphonates prostaglandin synthesis Nephropathy Digoxin Phenytoin and ibuprofen together Aspirin Inhibit prostaglandins Cutaneous (urticaria, Valproic acid (Salicylates) synthesis from arachidonic angioedema) Sulfonylureas acid by inhibiting both Respiratory isoforms of the COX enzyme (bronchospasms, (COX1 & 2) laryngospasm, rhinorrhea) Glaucoma drugs (MOA, Adverse side effects): Prostaglandin Analogs: MOA: increase aqueous humor outflow Includes: ○ Bimatoprost (Lumigan) ○ Latanoprost (Xalatan) ○ Tafluprost (Zioptan) ○ Travoprost (Travatan Z) Adverse side effects: ○ May cause darkening off iris and eyelashes ** prostaglandins = end in "prost"** Beta-Blockers MOA: reduce aqueous humor production Includes: ○ Timolol (Timoptic) ○ Betaxolol (Betoptic S) Adverse side effects: ○ Increased light sensitivity and reduced HR/BP Contraindications: ○ Heart block and bronchospastic disease **Beta-blockers = end in "olol" ** Cholinergic (miotics): MOA: increase aqueous humor outflow Includes: ○ Pilocarpine (Isopto Carpine) Adverse side effects: ○ Poor night vision due to pupil constriction, corneal clouding, GI distress ○ Precautions: hx of corneal abrasion or retinal detachment **Cholinergic = ends in "pine"** Carbonic Anhydrase Inhibitors: MOA: reduce aqueous humor production Includes: ○ Dorzolamide (Trusopt) Adverse side effects: ○ Sulfonamide allergy cross reactivity **Carb-Anhydrase Inhibitors = ends in "amide"** Adrenergic Alpha-2 Agonist:  MOA: increase aqueous humor outflow + reduce aqueous humor production Includes: ○ Brimonidine (Alphagan P) Adverse side effects: ○ CNS depression and anticholinergic effects **Adrenergic A2A = ends in "dine"** Rho Kinase Inhibitor: MOA: increase aqueous humor outflow Includes: ○ Netarsudil (Rhopressa) Adverse side effects: ○ Conjunctival hemorrhage or hyperemia ** Rho Kinase = ends in "dil"** Counseling point for ophthalmic and otic drugs Eye drops: Wait 5-10 min after administration before administrating a 2nd drop or different drug w/ ophthalmic medications Drugs must be shaken or inverted prior to use Don't touch applicator tip - cause bacterial keratitis Contact removal/reinsertion depends on formulation ○ Drugs w/ benzalkonium chloride (BAK) require a 15 min wait prior to reinsertion ○ Ointments are generally not used while wearing contacts Occlude the eye after administration for one minute Ear drops: Roll in hand prior to use - if drops are cold, they may cause vertigo Steady state definition: The rate of drug intake equals the rate of drug elimination Clearance definition: Rate of drug removal in plasma over time CYP 450 includes: CYP 3A4 - most predominant one for adults CYP 2D6 CYP 2C9 CYP 2C19 CYP 1A2 PS PORCS: Strongest Inducers Phenytoin Smoking Phenobarbital Oxcarbazepine Rifampin Carbamazepine St. Johns Wart G PACMAN: Strongest Inhibitors Grapefruit Protease inhibitors Azoles Cyclosporin & cimetidine Macrolides (not azithromycin) Amiodarone & dronedarone Non-DNP CCBs (diltiazem and verapamil) Phase 1-3 trials (know everything on slide, 1st ppt) Phase Purpose Subjects Scope Length of time I Safety, PD, PK Healthy volunteers 20-80 subjects 6-12 months II Safety and efficacy (dose response) Intended population 100-300 subject 1-2 years Usually those who are healthy but with the disease III Safety and efficacy at specified dose Wide range of intended 100s-1000s of 2-3 years and determining labeling population subjects Protein binding in relation to drug? How do we measure that? Protein binding has to do with distribution of the drug throughout the body Albumin = protein binding Bioavailability of medications? % of drug that reaches systemic circulation from site of administration Calculated as area under the plasma concentration time curve (AUC) Which ISMP practices are important? Leading zeros ○ "naked decimal point" ○.5 mg instead of 0.5 mg ○ Can be mistaken as 5 mg if decimal not seen ○ USE THE ZERO before a decimal point when less than whole unit Trailing zeros ○ 1.0 mg instead of 1 mg ○ Can be mistaken at 10 mg if decimal not seen ○ DON’T USE trailing zero for doses in whole numbers Bacteria: Morphology Enzymatic activity Which antibiotic do you want to use for that bacteria?? (know bacteria based off of lab information) Several ??s GRAM + Bacteria Morphology Enzymatic Antibiotic (treatment) Staphylococcus Aureus Gram + Catalase + Vancomycin Clusters Coagulase + Linezolid Cocci Staphylococcus Epidermidis Gram + Cluster Cocci Pediatric pearls slide - know everything: Reconstituted medications will expire in 10 - 14 days Some reconstituted medications will require refrigeration Clindamycin reconstitution needs to be flavored Cefdinir reconstitution will turn stool red even though liquid is not red - reaction with dietary iron Round the dose - do not make parent measure 3.89 mL dose Acute uncomplicated otitis media ○ Amoxicillin 90 mg/kg/day orally in 222 divided doses for 10 days Which antibiotics are IV and PO & Renal dysfunction - does it have to be dose reduced? IV antibiotics: Family Drug Names Renal Dosing Penicillin's ○ Penicillin G  ○ Nafcillin ○ Oxacillin ○ Ampicillin/Sulbactam ○ Piperacillin ○ Ticarcillin ○ Piperacillin/Tazobactam ○ Ticarcillin/Clavulanate Cephalosporins ○ Cefazolin ○ Cefoxitin ○ Cefotetan ○ Cefotaxime ○ Ceftriaxone ○ Ceftazidime ○ Cefepime ○ Ceftazoline Beta-Lactams: Carbapenems ○ Ertapenem ○ Imipenem ○ Doripenem ○ Meropenem Beta-Lactams: Monobactam ○ Aztreonam Aminoglycosides ○ Gentamicin ○ Tobramycin ○ Amikacin ○ Streptomycin Macrolides Fluoroquinolones Misc ○ Telavancin ○ Daptomycin ○ Tigecycline ○ Quinupristin/ dalfopristin PO antibiotics: Family Drug Names Renal Dosing Penicillin's ○ Penicillin V Penicillin - NONE ○ Dicloxacillin Dicloxacillin - NONE ○ Amoxicillin Amoxicillin - CrCl 10-30 mL/min ○ Amoxicillin/Clavulanate Cephalosporins ○ Cephalexin Cephalexin - CrCl 10-50 mL/min ○ Cefprozil ○ Cefaclor ○ Cefdinir Cefdinir - CrCl